Children and Youth — Issue No. 27 — Thursday, April 14, 2016 (HTML)

Present: Jane Thornthwaite, MLA (Chair); Doug Donaldson, MLA (Deputy Chair); Marc Dalton, MLA; Carole James, MLA; Maurine Karagianis, MLA; John Martin, MLA; Dr. Darryl Plecas, MLA; Linda Reimer, MLA; Jennifer Rice, MLA

1. There not yet being a Chair elected to serve the Committee, the meeting was called to order at 8:05 a.m. by the Deputy Clerk and Clerk of Committees.

2. Resolved, that Jane Thornthwaite, MLA, be elected Chair of the Select Standing Committee on Children and Youth. (Linda Reimer, MLA)

3. Resolved, that Doug Donaldson, MLA, be elected Deputy Chair of the Select Standing Committee on Children and Youth. (Carole James, MLA)

4. The Committee reviewed its Terms of Reference and 2016 Preliminary Draft Work Plan.

5. Resolved, that the 2016 Preliminary Draft Work Plan for the Select Standing Committee on Children and Youth be approved. (Maurine Karagianis, MLA)

6. The following witnesses appeared before the Committee and answered questions regarding the joint special report of the Representative for Children and Youth and the Provincial Health Officer: Growing Up in BC — 2015 (June 2015).

• Mary Ellen Turpel-Lafond, Representative for Children and Youth, Office of the Representative for Children and Youth

• Dawn Thomas-Wightman, Deputy Representative for Children and Youth, Office of the Representative for Children and Youth

• Bill Naughton, Chief Investigator and Associate Deputy Representative, CID and Monitoring, Office of the Representative for Children and Youth

The following electronic version is for informational purposes only.
The printed version remains the official version.

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH


CONTENTS
Page
Election of Chair and Deputy Chair	639
Committee Terms of Reference and Workplan	639
Representative for Children and Youth and Provincial Health Officer Report: Growing Up in B.C., 2015	640
M. Turpel-Lafond
P. Kendall

K. Ryan-Lloyd (Deputy Clerk and Clerk of Committees): Good morning, everyone. As this is the first meeting of the Select Standing Committee on Children and Youth for the current session and because the committee has not yet met to elect a Chair, the first item of business is the election of Chair. I’d like to open up the floor to nominations to that position.

Any further nominations? Any further nominations? Any further nominations? Seeing none, I will put the question.

J. Thornthwaite (Chair): Thank you very much. Welcome, everyone. Good morning. I think now we do the election of the Deputy Chair.

J. Thornthwaite (Chair): We have just one item to discuss before we get into our main item, and it’s the review of the terms of reference and the draft 2016 workplan. As everybody has had an opportunity to look at the draft, I guess what we’re looking for right now is just approval. Kate has got it at the front as saying it’s confidential because it needs to be approved by the committee before we can make it public, so I just wanted to know whether or not anybody had any comments about the draft.

We’re already into March to May, and we’re in the process of going through our representative reports, one of which we are going to see today and then, hopefully, the last outstanding one in the next meeting of this session. Then we’ve also got a joint report from the ministry and the hotels. We’re going to, hopefully, get that one in the next meeting, which we’ll discuss at the end of the meeting.

Then the other project that we do have to, at least, begin this year is the statutory review of the act. We have a letter that we got from the Attorney General, which Kate had distributed prior to the meeting, that also adds to that discussion but I don’t think changes anything with regard to the proposed timeline.

That’s basically it as far as our workplans for 2016 that we’re aware of right now. Is there anything else that you can remember?

I think the Chair has provided you with an overview of the contents of the workplan. You’ll note in the committee timelines that we anticipate ongoing meetings, of course, to continue to receive regular reports from the Office of the Representative for Children and Youth.

We’ve also included, in an appendix, some information about previous reviews of the act. The last time section 6, for example, was reviewed by this committee was in 2015. Just by way of context, that’s also been added for your information in the draft workplan.

Happy to answer any questions or to receive any input or feedback on any element of that.

C. James: The only piece — and I noticed we do have it continuing in June and September — is to make sure that we’ve got the ability to be able to meet with all the groups and organizations and ministries, following up on the letter, around the statutory review. We’ll need enough time to be able to do that.

I expect that you will see some of the First Nations organizations provincially that will want to meet with us around the review that we’re doing; other ministries, as the AG pointed out. I just want to make sure we’ve got enough time in there. If we’re starting those meetings in June and then we’re looking at preparing the report in September, summer is tough for a consultation.

That’s the only piece that concerns me a little bit. We need to make sure that we’ve got sufficient time and the right time for people to be able to meet, that we give them enough notice and that we set some dates. I think that time frame may need to be looked at.
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J. Thornthwaite (Chair): Yeah. There actually is no rush. We do not have to complete the review. We just have to be able to start it before April of 2017. Isn’t that the date?

J. Thornthwaite (Chair): I agree with you that we need — whoever wants to present — to allow them the opportunity or at least to provide us with input.

D. Donaldson (Deputy Chair): Likewise, I think in the fall would be prime time for hearing from groups. I think that in our next meeting, I’d be more prepared to be submitting names, especially of First Nations organizations that should be contacted.

I think, too, we have to consider the people who actually are recipients of the reviews by the Representative for Children and Youth and have the actual people who are the users, or the reason for the service in the first place, to come and give their submissions to us as well.

L. Reimer: I just want to concur with the fact that summer is never a good time, so either start that process before or after.

J. Thornthwaite (Chair): All right, then. We’ll carry on with the draft. Is everybody okay with us approving this plan today, or should we put that off for another day? I mean, I’m okay with it. Motion to approve it.

The next item is our main item for this morning: consideration of the joint special report by the Representative for Children and Youth and the provincial health officer: Growing Up in B.C. We have our two officers here, Mary Ellen and Dr. Kendall.

Representative for Children and
Youth and Provincial Health Officer
Report: Growing Up in B.C., 2015

M. Turpel-Lafond: Thank you. Good morning, everyone, and congratulations to the newly constituted, reconstituted, committee and new members of the committee.

I’d like to begin by just introducing the senior staff from the representative’s office that are with me today. First of all, to my right and your left is Deputy Representative for Children and Youth Dawn Thomas-Wightman. Of course, Dr. Kendall you know. I’m very pleased to be presenting with Dr. Kendall today. He’s not from my office, but close collaboration during my time as Representative for Children and Youth between our offices. To my left, your right, is Bill Naughton, who’s the chief investigator for the representative’s office and also an associate deputy representative.

Also, in the gallery, I’d just like to introduce Blair Mitchell. Blair has been an advocate with the representative’s office and has a very distinguished record of advocacy service in organizations in British Columbia and Scotland. He has recently taken on a senior leadership role in advocacy in our office, so he’s attending today. If you haven’t had a chance to say hello to him, please do so.

As well, with him in the gallery is Brian Hill, who is from my monitoring, research, audit and evaluation office. Brian was the lead staff member who collaborated with Dr. Kendall and his staff on preparing the report that we’re presenting today. Also in the gallery is Jeff Rud, who is the communications director for the representative’s office and does stakeholder and community relations.

You will note in the report today that there is a wide variety of experts that we engaged, national and international, and also stakeholders, to produce this report. So I’d just like to recognize the staff.

With that, I’d like to begin. As I said, I’m very pleased to be joined today by Dr. Kendall. Dr. Kendall and I have worked closely together on four reports — this is the fourth report — that look very comprehensively at issues around what we might call the determinants of health, the health and well-being of children in British Columbia, that include different domains of health and have a very strong shared professional focus on looking at indicators and outcomes and using well-informed information to guide policy and understanding and improvement.

This report that we are presenting on today, Growing Up in B.C. 2015, was released last year, and it was a follow-up on a first report — which was Growing up in B.C. — that was released six years prior.

Again, I’d like to recognize the amount of work that it took to put that together, to bring together information to get a sense of how children are doing in British Columbia, not only subsets of children that this committee is particularly concerned about and my office is mandated to support — such as children in care, children with special needs, children and youth and their families navigating the mental health system or the special needs system — but all children. One of the important issues is to understand how all children are doing so we can understand if there are gaps or differences.
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Also, Dr. Kendall and I have a very strong approach with other partners to understand whether there are different regional variations on how well children are doing, right down to looking at school districts, looking at health authorities, looking at issues that this committee will be well familiar with, particularly around mental health. Areas where there are gaps in data, or perhaps no data, and where policy, practice and the experiences of children, youth and their families…. It’s acutely important that we pay attention. This report comes out of that context.

I really want to publicly thank Dr. Kendall for that collaboration and the multiple opportunities that we’ve had to work on a research- and outcomes-based focus. Dr. Kendall also has participated extensively and is a very strong partner in the Children’s Forum, from the day that it was created, to look at how we can have a broader British Columbian approach to learning from experiences where there are deaths and injuries of children and youth. We have a very positive collaboration. I certainly appreciate the demands on his time and his staff and his constant involvement, interest and commitment to issues for children and youth.

With respect to this report, we looked at six key areas of well-being. We looked at child physical and mental health; family economic well-being; child safety; child learning; child behaviour; and family, peer and community connections. These were the domains, if you like, that we looked at. They do track a perspective or an approach that we brought to this work which is really consistent with a perspective about understanding and protecting the rights of kids and looking at different domains and matching up a perspective around the UN convention on the rights of the child and the determinants of health.

It’s a unique approach, and I think it’s a valuable approach. I hope it’s an approach that we will see repeated periodically, in the future, with these reports.

This time when we produced this report, in contrast to six years prior, we had some serious data limitations. We did engage the McCreary Centre Society, which is an organization that, again, we’ve had a strong partnership with. They were able to engage with more than 200 youth across B.C. We made sure that there was a strong focus on amplifying and reflecting the voices of children and youth. In particular, the adolescent health survey is a very important tool in British Columbia. And a more targeted set of youth engagement strategies were used to inform this report.

As I said, we solicited commentary from independent, academic and community experts, which were largely either Canada research chairs or recognized international experts that we shared data sets with. We talked about the findings and so forth. So there was a quality methodology to the way we prepared the process.

A key question that this report addresses is really: are we able to report, in 2015, significant improvements in how our children are doing in British Columbia compared to five years ago? A very important benchmark, and we need to have these types of waypoints with respect to a broader view of how children are doing in British Columbia.

We do have siloed views, and as the committee knows, we often have siloed approaches, sometimes to the same children. Addictions may be in the health care system. Mental health may be dealt with in the health care system and the Ministry of Children and Families system. Education needs may be met in a myriad set of ways. We frequently have silos, but being able to talk about it across the board is significant.

Were we able to look at significant improvements? There are areas where we saw improvements, and we’re happy to discuss this today. But across British Columbia in an overarching way, looking at these domains, the short answer to the question about if there were improvements is no. Particularly for the province’s most vulnerable children, those who have multiple vulnerabilities that intersect — such as families and children in poverty, families and children navigating the system of mental health supports and contact with the government’s care system — you’ll see Growing Up in B.C., 2015 says that for that cohort, life has not gotten better.

In most cases, these are the children that start out behind their peers, and they remain behind. Those outcomes, gaps, follow them throughout. There are particular points of vulnerability.

I would say that the findings…. I know Dr. Kendall will speak to them further, but at a high level, when we reflect on the first report and the second report, it encourages me to come back to a concept that certainly Dr. Kendall and I have discussed over the years extensively and that I’ve put out repeatedly as representative. That’s the need in British Columbia to have a coherent children’s plan that is a governmentwide plan for children and that will actually be able to address the areas of deepening vulnerability — and be more agile at responding and reporting to it.

It would regrettable if, say, with the departure of myself as representative and Dr. Kendall’s future…. I’m not sure what it is, but eventually there will be someone else in his role, I’m sure. It would be unfortunate if these types of broad reviews weren’t done. I think there is a strong possibility that not only do we not have that cross-government children’s plan that removes those silos, but we may not have any way to look at indicators and outcomes for children and have those waypoints.

There are a number of other projects that we’ve been participating in around indicators for children’s health, and so forth, that we aggressively support as being valuable for planning and response. But this is a significant project and a significant broad project that allows us to talk about children’s well-being, generally.
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I’ll stop there and let Dr. Kendall describe the report’s findings. Of course, we’re very happy to respond to any questions you have.

P. Kendall: Thank you very much, committee members, for allowing us the opportunity to present this report to you. I was scheduled, I think, sometime previously, but due to a norovirus event, I had to cancel, so I’m happy to be here today.

I’ll thank Mary Ellen for leading off and positioning this report as a follow-up to our earlier report. I’d also like to acknowledge that the work that our two offices could do together makes a significant contribution to my ability to report under my mandate, under the Public Health Act. It really does enhance that capacity of the office when we work together.

I would like to say, as well, that the data in this report…. Although it’s a 2015 report, depending on the indicator, some of the latest information we have is up to 2011. Some of it is up to 2012. I think the most recent data we would have is up to 2013. I will be addressing that in the future, and I’ll touch on that in a moment.

I would like to acknowledge the nearly 230 children who took part in this and looked at our metrics and gave some meaning to them from their perspective. I’d also like acknowledge the academic experts who looked at our data and also put their perspective on what the data meant.

I would just like to add to Mary Ellen’s emphasis around the importance of having accessible data. We do have data gaps. We had additional data gaps. I think that’s going to be fixed now that the long-form census is going to be back in operation. That will give us a broader database, particularly when it comes to higher-risk or more marginalized populations, for whom we lack the data.

I am preparing, with Child Health B.C., a much more detailed report on looking at 51 indicators, which will be released later on in the year. That actually covers the age span from infancy to emerging childhood. It looks at measures of physical, mental and emotional health; social relationships; cognitive development; and economic and material well-being. I would be happy to receive an invitation to present to you on that report once it has been released and finalized. I think it would add to the information that we add today, and it will certainly update some of the data.

This present joint report examines a subset of those indicators. It compares the health and well-being indicators, social status and achievements of some of British Columbia’s most vulnerable children with their less-vulnerable peers. We were not able to compare on all the measures that we looked at in 2005. Part of that is due to the fact that some data has been lost, and the long-form census wasn’t available to us. That would have filled in some of the gaps.

We have less data. What we have for this report is somewhat less reliable, but I think that in the future, we’ll be able to fill in those gaps. However, we can report that while there are important regional variations — and they will show up in my latest report as well — I note particularly those gradients of measures of vulnerability at kindergarten area. That’s an area of increasing vulnerability, unfortunately. Looking at the indicators for a healthy start in B.C., there are some that are positive. I’ll talk about those first at a higher level.

Maternal smoking during pregnancy is decreasing. Our infant death rate is relatively steady, as is low birth weight — around 4.1 percent. Those are significant indicators. However, we do know that lower rates are achievable, and we know how to drive those rates to improvement as well. That will be a priority. We also know that the high birth weight rates, which are an indicator of risk for later illness — diabetes, etc. — are coming down as well.

When we look at the number of children living under the low income cutoff, that has risen somewhat since the 20-year low that was reported in 2008. When we measure this — I think our last measure was for 2012 — about 11 percent of single-parent families fell into the category of poverty.

Our external commentator noted that if we were using a market basket measure — that’s the cost of market basket of food — instead of the low-income, after-tax measure, as some other jurisdictions do, the number of children living with marked material deprivation would be nearly twice as high. It would actually be at 21 percent, and almost one in five.

Depending on the measure you use, as long as you’re measuring consistency, you can see the trend. But if you’re looking at absolute need, our external commentator suggests that we should use a more sensitive measure.

That would actually translate into over 70,000 households with children who experience moderate to severe food insecurity. Our latest report suggests it’s particularly worse in the north. We have regional differences in B.C. We also have differences within regional health authorities in B.C.

However, we can report that while there are important regional variations…. I note particularly those gradients of measures of vulnerability at kindergarten entry. Overall, when we look at the indicators for a healthy start, as I say, maternal pregnancy smoking is down, infant death rate is steady, and low birth weight rate is steady.

When we look at early childhood development, we’ve noted that the number of preschoolers who have vulnerabilities in at least one domain, as measured by the early development index that was developed by Clyde Hertzman at UBC, it’s now approximately one in three, which is increasing. While Vancouver saw a drop in vulnerability scores, 13 of the 16 regions saw vulnerability increase in at least one measure, so that is of concern.
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When we look at behaviours, most youth — that is, about 72 percent — get at least three hours of physical activity a week. That’s below what is recommended, but it’s better than just about any other jurisdiction in Canada. While many of them do get their recommended six to eight servings of fruits and vegetables, not enough do. We don’t meet the target for that. That’s probably true for adults as well as children — an intergenerational phenomenon.

So 72 percent usually feel good about themselves; 86 percent had never met anyone on line who made them feel unsafe. Teen pregnancy rates are steadily dropping. There have been significant declines, about 31 percent, in serious violent crimes and a 71 percent decrease in serious property crimes. And there were, when we did this measure, 25 percent fewer children in care.

Other good news: initiation of alcohol and cannabis use before the age of 15 is declining, and it is still declining. On the other hand, about one in three children and youth reported experiencing stress or extreme stress in the last 30 days. The rate of recurrent abuse and neglect, however, does remain steady, at about 20 percent, so we need to pay attention there.

Unfortunately, other than the rates of suicide and admissions to hospital for mental health challenges, we had very little reliable information on the rates of mental wellness or mental health challenges or diagnosed mental disorders in this population. We do know that in 2012-2013, 2,133 children were hospitalized due to mental health problems. Better data are needed.

After years of almost steady year-upon-year declines in youth suicide, we did see an uptick in the three-year moving average for youth suicides in 2009-2012, but I think that my next report will show that we’re back on a downward trend. Suicide or suicide attempts are a really severe marker for mental distress, and it will be a focus of the First Nations Health Authority in the upcoming years.

The picture for educational achievement is more complex. Overall, high school completion rates increased for all children. For non-aboriginal children, the FSA scores are slowly going up, although these data may be biased as more children are not taking part in these assessments. Many children who are not deemed to be doing well are often held back, and so you get a selection bias towards kids who are doing well.

As noted, both aboriginal children and children in care significantly increased their high school completion rates, and some of the gap between these more vulnerable youth and their less vulnerable peers appeared to be narrowing, in the data that we looked at. The importance of school and family connectedness is reinforced by its high correlation with intent to remain in school.

Overall, many of the indicators did show progress, although not to the extent that we ideally would have liked to see. Others showed little or no change from 2005, and on a less optimistic note, there continued to be too many vulnerable children in B.C.

I’m actually going to now hand the floor over to Mary Ellen, who’s going to talk about the gaps that the report finds between the general population and some particularly vulnerable children and youth.

Zoning it in a little bit more to the children and youth that are frequently the target of the work of my office, and also this committee, the report, as Dr. Kendall has indicated, speaks to some serious concerns around well-being of these cohorts of children and youth.

Dr. Kendall mentioned the issue of recurrence of maltreatment, which is something that I know we talk about frequently here. A stable measure, a recognized national and international indicator of the prevalence of child abuse and maltreatment, can include physical or sexual abuse but also neglect. The extent to which, after there’s been a single incident of investigated and confirmed maltreatment, a child experiences another confirmed, is the recurrence. There are significant parameters around this.

I just highlight this for the committee again, because we frequently…. You will note that Dr. Kendall and I, in this report, and the team of experts who have validated and participated do not use as a measure, for instance, the number of children in care.

We use as a measure the level of maltreatment and recurrence of maltreatment, because the number of children in care is not a stable reflector of how broad maltreatment is. It’s very easy with the stroke of a pen to remove everyone from care or to take everyone into care. You can be too broad or too narrow. The issue of our children experiencing maltreatment after a single incidence where it’s been investigated and responded to — is it recurring? Are they returning to a situation of maltreatment?

That is one area that I just emphasize for the committee because this is an indicator that we can never back away from if we really want to make progress. As Dr. Kendall indicates, we would have liked to have seen the level of recurrence of maltreatment decline in British Columbia. That’s a very key thing.

Are we responding to neglect, physical and sexual abuse in a way that is eliminating that in the lives of children and families? Are we making progress? Is that progress consistent geographically and consistent among a range of populations? The other way of saying it is: are there some groups of children and youth in some places where there’s a significant recurrence of maltreatment, and are we marshalling our resources and thinking to those regions and areas?

I’m talking about an approach and a strategy with data that we’re not at, at this point. But a sensitivity to that is significant — again, in my work overseeing the child
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welfare system, engaging with the ministry, encouraging them to adopt a quality assurance and performance management system that actually focuses on these issues — making it clear that things like the number of kids in care, while significant, obviously, at one level, is not the significant issue to understand the prevalence of neglect or maltreatment in British Columbia.

We continue to have a significant and stable — unfortunately, regrettably stable — level of recurrence of maltreatment, which suggests that we need to be continuing to do significant work.

Among the populations where levels of abuse, neglect and maltreatment are elevated, of course, are aboriginal children and families, as this committee knows. It doesn’t mean every aboriginal child and family, but overall, there are significant concerns.

You will see in this report again that despite just constituting 8 percent of the total child and youth population, aboriginal children account for more than 60 percent of the children in care, meaning CCO or CIC status. That was at the time of reporting. That has since gone up. The current check-in on that data is that it’s approaching 70 percent, and all signs point to that this will continue to rise.

With respect to a broader picture, you can see that aboriginal children and youth in British Columbia are 12 times more likely than their non-aboriginal peers to be in government care in British Columbia, and one in four, 25 percent, will have contact with the child welfare system, which, again, is grossly disproportionate to other groups of children. So when we really zone in on vulnerability…. The committee will be aware of this from some of the specific reports and work of my office.

However, broader, British Columbia–wide, we see that this becomes very clear around the type of vulnerability that aboriginal children and young persons have across all of these domains that we identify in the report — physical and mental health. Cognitively, with respect to the education outcomes, aboriginal children are far more likely to receive a school-leaving or Evergreen as opposed to a Dogwood.

When we analyze and take into account the proportion of children with special needs in a school district, it still does not wash that that many children would have school-leaving certificates as opposed to Dogwoods and would not be completing. So the vulnerability is significant, and in fact, in a way, it’s quite staggering, and it’s continuing.

From what we’ve seen over five years, we haven’t seen a marked improvement. We’ve seen some areas, as Dr. Kendall suggests, around birth weights and a few other areas, but in terms of the full span of childhood and the physical, mental and cognitive milestones that are connected with outcomes, we continue to see gaps.

Sixty percent of youth in care with a continuing custody order do not graduate from high school within six years in British Columbia. Fifty percent of the youth who age out of care — again, the committee will be well familiar with this from some of the other reports and work of the representative’s office — rely on income assistance within six months of leaving care. Others, it’s unknown — their status.

This is a more in-depth look, in particular, at the learning domain. Dr. Kendall and I were of the view that we would focus more on the learning domain as a significant one.

Dr. Kendall has spoken about the EDI. We also looked at other aspects of the learning domain. About one-fifth of high school students in British Columbia do not take grade 10 language arts or math 10 on time. Those are courses that are required for graduation. The graduation requirements change, but we’re talking about 25 percent of students that are not taking that on time. That’s a very broad number, and it suggests that there may be some issues, more broadly, that might be concealed within what the education achievements are for all British Columbian children.

Although people with post-secondary education are more likely to be employed than their peers with only high school diplomas, three-quarters of those who graduate from high school within six years of entering grade 8 go on to any secondary training. So we’re still losing 25 percent that graduate but do not do any post-secondary training. Those numbers are about 10 percent lower, again, for aboriginal youth and significantly lower for aboriginal youth and youth who have been in the child welfare system.

I’m speaking about some of the gaps. While they may be known and they may not be new to members of the committee or public, since we did the report in 2015, these are persistent gaps that require monitoring and a response and a plan of some kind to consistently evaluate that across what we have — as I said earlier, that is effectively a siloed system.

Certainly in British Columbia, when we look at one of the biggest causes of vulnerability — when we weigh everything else, multiple factors at both the macro and micro level that lead to intense child vulnerability — what comes out loud and clear and in fact kind of screams out when you look at it from a data perspective, is material deprivation or poverty.

Again, in my hat as an advocate, I’m suggesting that we need either some type of a clear children’s plan in British Columbia that has a focus on material deprivation — those children in families that are experiencing that 20 percent of not being able to have, on the market basket measure, adequate needs met for their children — or, alternatively, some type of a cross-ministry plan to address poverty.

As Dr. Kendall indicated, we looked very carefully at what the measures are, and market basket measure is
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one that experts do promote. The government of British Columbia at this point does not embrace that as a measure and has not landed on its measures, so we continue to have a fairly unstable discussion in this area. We certainly think that on material deprivation, a deeper, more sustained set of indicators and evaluation and markers would be valuable.

Every year in November when the child poverty statistics, if you like, come out in terms of LICO and other reports, we tend to have a ping-ponging debate which is very divided and, with respect, not very helpful. We think that actually there is a way to look at these indicators and talk about improvements over time.

It’s not about finger-pointing about who is or isn’t responsible but actually how we can marshal together a more collaborative and effective response so that children and families that experience material deprivation and all the antecedent impacts of that can be supported to be more resilient and successful.

Again, British Columbia is the only jurisdiction in Canada without a poverty plan and without that measure, so we note that as we go forward. It’ll be very important to carefully monitor and study health and well-being outcomes data for children and youth across the province as we go forward.

My office has been very supportive to the child health indicators initiative that Dr. Kendall and a team have been undertaking for a period of time. We think that’s particularly valuable.

We also feel very strongly that a subset, an evaluation of the needs of these children and youth with these intersecting vulnerabilities, particularly in the child welfare system, needs a continued strong focus so that we can have a higher-level understanding of whether or not children and youth in British Columbia are doing better and in which way — and, of course, using that information to inform policy.

On that final point, I would just say that these reports are used in different ways. Obviously, we are using valuable public resources to try and produce reports that can inform and support policy and discussion.

Some very good discussion has occurred since the 2015 report with the First Nations Health Authority, as an example, who have effectively taken the structure of the report and wanted to put in place a broader plan to see improvements across British Columbia for First Nations children. That’s at a planning and conceptual stage, but I think that’s a very valuable partnership. It’s emerging; it’s developing.

I know that Dr. Kendall and myself have been in some conversation around that, how we can support that and use the information to inform that. Otherwise, the information in Growing Up in B.C. is used fairly widely in the college and university system in British Columbia, in faculties that look at the human sciences and human services. There’s a fairly significant use of it, which I really think is important as well, from a research perspective.

I just put that forward to say that it’s always an opportunity to spark further research. However, without the legislative ability in the representative’s statute, and somewhat matched by the legislative capacity of the provincial health officer — we have access to some data sets that no researchers would have access to. Preparing anonymized data sets so that other research can be done is really significant.

We note that there are some major impediments that continue there, where data sets are not available or are not publically available to support that. So this type of report is significant, and it is important to have other researchers to look at it and evaluate it.

Quite apart from that, there is a target audience, which is really significant, which is officials within the public administration of the government of British Columbia who are responsible, in some form, for developing appropriate social and economic policies to be able to support vulnerable children. Less engagement and discussion at that level, I would have to report.

I had hoped, when the first report was developed, that this would be a report that the government would provide and on an annual basis, so I’m glad we’ve done another one. I hope we’ll have future ones. I think it’s, as I say, a waypoint for how it can be looked at.

I’ll leave it there. I’m delighted to take any questions, as I know that Dr. Kendall is.

M. Karagianis: Thanks very much for this report. In one of your observations about school readiness and early learning, which I’m particularly interested in…. I want to know if you can comment on any correlation between early intervention, early diagnosis and therapies and other supports for very young children. Certainly, it’s one of the things that we frequently hear about in our community offices — the challenges around that.

In any way…. I realize you haven’t really commented on that here, but I’d be interested, Dr. Kendall, in hearing your opinion on that.

P. Kendall: A couple of years ago the Ministry of Health, through the regional health authorities, launched a program called the nurse-family partnership, which is identifying higher-risk first-time mothers. It’s based on a program that has been successfully evaluated through randomized control trials in the U.K. and the U.S.

It provides intensive nursing supports for the most vulnerable women who are young first-time mothers. It starts early in pregnancy, before the 26th week, and extends out to age two. It’s about halfway through. It’s being implemented in B.C. on a randomized control trial basis, comparing those moms who get that very intensive intervention with moms who get the usual care.
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We would anticipate that we will see significant improvements through that intervention. If we do, then we’ll be taking the successful parts of that and broadening it more broadly across the antenatal spectrum to identify mothers or families early and put those enhanced supports into them. Most of the health authorities, even though this is a focus, also have targeted, higher-intensity support programs for mothers who are at risk.

Another observation that we made fairly early on that came out of the human early learning partnership was when we were looking within the city of Vancouver. Children who were from mixed-income neighbourhoods, where they had the benefits of high-income or middle-income families living with them, even without any additional programming did better than children who just grew up in low-income areas.

They didn’t do quite as well as children who grew up in just high-income areas. So just city planning or community planning that puts in a mix of income and a mix of facilities actually has as much of an impact on the kids who are growing up in low-income families as targeted social work intervention programs do.

We also know that you can identify children who will have problematic behaviours quite early on, at school entry. Programs that will assist them in becoming numerate or literate or in addressing whatever deficits they have actually improve the outcomes later on.

We still, I think, tend to put our resources downstream, when problems have developed, rather than being able to move them further upstream to try and prevent those problems occurring or to mitigate the effect of those problems.

I have three questions regarding aboriginal children. There was a comment in the report that mentioned that the number of aboriginal children in care was about the same as how many were in residential schools. Did I misread that? I should find that. I read that in the report. Is that actually the case?

M. Turpel-Lafond: Yes. The correlation between the intergenerational impacts of the residential school experience and the involvement in child welfare is significant. The recent Truth and Reconciliation Commission report included a call to action on child welfare and similarly confirmed what was in this report, which is that those numbers, ironically, seem to track. A very different time and era. The number of aboriginal children that have some experience with the child welfare system or in care…. As I say, it’s 12 times. It’s staggering, the disparity.

It speaks to an issue, which is the type of intervention, as a society, we take to child vulnerability. That is not to say that those children haven’t experienced neglect or maltreatment but whether or not we’ve actually addressed some of the presenting issues around prevention, which is why this report tries to pull back and talk about some of those areas.

For aboriginal families, the deeper vulnerabilities relate to poverty, challenges around housing. The maternal and fetal health issues are significant. Dr. Kendall was just speaking about that important project on targeted nurse home visiting. There were times in the history of British Columbia when there was a universal nurse home visiting program. Now it’s a targeted rollout to look at how to improve. That’s significant, but it’s not always matched with, for instance, the needs of aboriginal families.

This is an area where silos come into effect. I can speak just on this issue. There are places in British Columbia that have a very high rate of removal of children at birth, hospital removals. Those are usually aboriginal children. We can name the top five communities where that happens. One would want to match our nurse home visiting programs with the Ministry of Children and Families in its regions, working with the Ministry of Health and the First Nations Health Authority, so that we target to those vulnerabilities.

That’s an example of…. I’m sure everyone here would say that sounds like rational planning. It doesn’t happen. The community that has the highest rate of removal doesn’t have a rollout of this program. We’re trying to promote that, but your question really begs the issue. These are some known challenges that we’ve had, not only provincially but nationally.

What this report can speak to is the types of interventions that are based on the evidence around what may or may not work and can support and prevent what we want to prevent. As Dr. Kendall says, upstream, not downstream.

M. Dalton: Just a follow-up question. When I was on the committee five years ago, the number of children in care, I think, was approximately 10,000 or more, and it’s gone down to about 7,000 — a significant decrease. There have been some real changes in approach, I imagine — putting in homes of kin and others.

I’m just wondering if you can comment on that as far as being something positive. What’s behind a lot of those details as far as the numbers going down?

M. Turpel-Lafond: I think that’s an astute question. That’s really a key issue — to be very well informed on how to interpret that, as legislators. It’s very significant. One can point to a reduction of the number of kids in care and say that’s a good sign.

What we’re suggesting here is that we need to look at maltreatment. We have had a stable level of maltreatment, neglect and recurrence of maltreatment, yet we’ve had a decline in the number of children in care.

We’ve had a 40 percent uptick in the number of youth living independently while in care. Foster care is sup-
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posed to be a temporary initiative, to then place a child in a family setting. We still have a large population of children spending an entire childhood in care. Some of them are aging out, and some of the numbers are coming down in some ways. I would caution you strongly against seeing this as some type of a measure that’s positive.

We should try to have a reduction in terms of the period that children spend in foster care. The number of children in care is not a stable indicator. Really, it’s the number of children who experience abuse, maltreatment and neglect. It could very well be that the Ministry of Children and Families has decided not to investigate a certain class of cases of neglect, for instance. Or, as a society, we decide not to respond to the reasons why children experience persistent neglect — substandard housing, poor food, family violence, etc.

The relationship on the ground is to look at the quality of the child’s experience in terms of meeting their developmental needs — their physical, emotional and cognitive needs. One of the things that this report speaks to — and when I talk about the children’s plan and the grist for the mill in the regular discussions that Dr. Kendall and I and our offices have — is we do not have in British Columbia a set of minimum outcomes for those key domains. We’re reporting today on what we see in the indicators, but we haven’t said: “All children in British Columbia will have a certain level of cognitive development at certain stages.” The idea of having a children’s plan or framework for children is something where we are challenged.

You look at something. You pull out something like: “Okay, what about the number of children in care? It’s coming up or down.” Yeah, that’s a significant conversation. Just be very cautioned about what you draw from that. It’s possible to have a situation where we’re very pleased to report that there are no children in care in this region. Yet we have suicides, we have deaths of children, we have prosecutions for assaults of children, we have children that are underfed or malnourished, and we have children that are not in school. So we know that there’s child abuse and maltreatment.

This is why there’s a chart that I’ve encouraged the Ministry of Children and Families to develop. It’s one of the most important pieces of work I think they do through their data piece. It’s a chart that really looks across the province and tells you that in some parts of the province, there are interventions, and in some parts, there are not. The child welfare system does not have a stability to it.

The number of children in care…. In a perfect world, we would have no children in care. They’d all be in a family setting. We all know that. What we really need to pay attention to is: are children experiencing physical and sexual abuse? Are they neglected? Are they being exposed to violence? Are they actually being supported? That’s the policy driver.

We have about 7,000 kids in care compared to where it was maybe 11,000. We work hard to have permanency and have kids out of care. At the same time, we have had a burgeoning number of kids in independent living prior to their maturation. Certainly, there’s a debate about whether at 19 they’re mature enough to live independently.

We have moved that. I’m not saying we’ve juked the stats or whatever, but we definitely need to be very careful about how we look at that and have a common and stable set of indicators and outcomes.

The report calls out — the representative has just spoken about it but I think in the questions that are coming as well — for that comprehensive plan, whatever you call it. I don’t think it matters what it’s called, whether it’s a poverty plan, whether it’s a child wellness plan.

I think what’s so clear to me in all of this is that we can pull out all of these stats. We can take a look at each of these indicators. Unless we have a comprehensive plan that includes all of the ministries and all of the organizations and all of the communities that are involved in this, we will continue to piecemeal this approach. We’ll continue to look at single stats and not recognize and support the integrated approach, which is the only way that we’re going to resolve any of these issues.

I guess my question is: have you had — and it’s not your jobs, because it’s not part of your mandate — ministries or school boards or provincial organizations come to you after this report was released to talk about how they could utilize the information? I think it would be such a waste, I guess — I don’t know how else to call it; it’s an important report — to not have groups and organizations begin the work.

The ideal work, of course, is an integrated approach. But I would hope, for example, that the School Trustees Association would look at the education results. I would hope that the Ministry of Aboriginal Relations would be looking at the results, and the ministry for housing, etc.

I guess my question is: what kind of approach has occurred? I don’t want to call ministries out, but what kind of approach has occurred around people asking to utilize this information — I think not only on how to improve things and look where the challenges are but also to look where the successes are, at where there have been positive changes? If we don’t learn how those positive changes have occurred or where there are challenges, again, we’re not going to fix it. I just wondered what kinds of discussions have occurred out there.

P. Kendall: Speaking for the Ministry of Health, or the regional health authorities, these data are being used at a regional health authority level, when they’re trying to build healthy communities or healthy schools or target
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the prenatal programming, for example. We know that you get a big return on investment. For every $1 spent in some of these prenatal infant support, early childhood development families, you get kind of a $7 return in social benefits, decreased crime, and the benefits go out for about 20 years.

The chief medical health officer in the Northern Health region has just released or is just about to release a report looking at child health indicators in the north, with some recommendations as to what could be done there. From my perspective, I think work is happening in the region at health authorities at the local level, within the public health area, where they work with municipalities to try and build those healthier communities. So some work, yes.

M. Turpel-Lafond: I think there’s pretty significant work not only to develop this but, again, recognizing the work of Dr. Kendall and his staff, and mine as well. This type of report does get…. We have a lot of engagement with trustees, principals, vice-principals, teachers.

Other communities — what’s problematic is that they don’t actually all come together. As you’ve seen in mental health, as a good example…. Well, there is a problem in mental health because there’s no data. There are the pathways that children and their families experience and that they want to talk about. They want to have those pathways identified. But sometimes those pathways take them through a school, through an emergency room, through a community service, and then sometimes they’re not served.

You have to get everyone together to talk about: if we’re going to engage in mental health, if we’re going to reduce the distress level of children and young persons and their families, we need a governmentwide and society-wide policy. We still have these silos. I think that is the challenge. The debriefing it is really valuable, but debriefing it from a perspective which, from this side, is a pretty strong one, which is: we remove silos; we look at indicators.

We understand, like on child maltreatment and aboriginal children, one of the interventions at the micro level that likely would have significant impact would be to increase parental warmth — meaning, parenting programs designed for parents and caregivers who have gone through intergenerational trauma of residential school and other issues, possibly some self-destructive behaviours because of that. You develop a parenting program, probably delivered through a health system, that’s low-barrier and is focused on parental warmth, because that’s very correlated with less distress in children and more resilience.

That’s an example of an evidence-informed micro-level…. But we’ve never done that. We actually don’t have that in British Columbia yet. It’s one of those areas that Dr. Kendall and I are talking about with the First Nations Health Authority and others, but we don’t have the Ministry of Children and Families. It continues to be a divide-and-conquer — I mean, not intentionally. It’s a continuation of a very fractured approach and often very positional and very turf-oriented.

That’s regrettable, because the micro and macro factors that are connected to improving and responding to some of these require not only debriefing with different sectors but the overarching approach. We really haven’t made that effort in British Columbia. We don’t have a children’s plan. We don’t have an overarching poverty strategy that could be a way into that. We have limited strategies that we are gauging, often, on a pilot project basis.

Certainly, in my time as representative, they have a lot of hiccups and stops and starts. Certainly, Dr. Kendall was closely involved with the healthy living strategy, which showed remarkable benefits, and it was stopped. We see the stops and starts, which doesn’t mean that we get discouraged, but we think there’s a lot of room to do this a bit differently.

P. Kendall: There is an office for the early years, and Tessa Graham is heading that up. Their work mostly, I think, at the moment is focused on connecting with the various communities in community groups who are working at the sort of grassroots level, which can be challenging because there are a lot of them. Trying to pull them together into a coherent whole is difficult.

With the First Nations Health Authority, we have been looking at one marker for family or community dysfunction, which is youth suicides. As you probably know, they are not evenly distributed across communities. According to the work at the University of Victoria, there are over half of communities that did not report a youth suicide in the prior ten years, and there are others where the curve…. There are significant communities at risk.

There’s been a reluctance to name those communities, but the health authority now and the First Nations Health Council are really making this a focus and a priority, because this is an indicator, I think, of deep vulnerability. It relates to the issues of the multigenerational impact of residential schools and dysfunction. But it has to be approached, I think, with delicacy as well as with targeting. Building the communities back one family at a time is probably a strategy that they will be adopting.

D. Donaldson (Deputy Chair): Thanks for the presentation. I recall when the report came out in the fall, I believe, we reviewed it amongst our side and our team. These kinds of presentations actually enable us to have a more fulsome appreciation and discussion of all the factors — so thanks.

I couldn’t agree more around the gaps and the child needing some kind of a child plan, and poverty being the common theme in addressing a lot of these gaps and
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a cross-ministry plan needed to address that. I think of the material poverty that you’ve talked about and also the spiritual poverty, the mental and emotional poverty that we see. Those two are connected, of course. But even at the basic, material poverty….

It strikes me, in the report on page 35, that we have almost 16,000 households with children that had severe levels of food insecurity. This is in the province of B.C. We’re not talking about a country that is impoverished economically; we’re talking about B.C. That’s really striking to me — the fact that 7 percent of kids who have had interaction with the child care system in the province are going to bed hungry. I think those are just unacceptable. I don’t know how we can characterize it as anything other than unacceptable.

On the food security issue, when you talk about regional differences, in the north, much of the food security is connected to the land base, whether it’s the jarred fish in the pantry or the moose meat in the freezer. I mean, these are real reasons why people aren’t experiencing a higher level of food insecurity.

I would take the cross-ministry approach even further than simply the ministry silos that are typified as the social services side. I think we need a cross-ministry approach that brings into contact all ministries. I think of development projects that are proposed that could impact the food security of people who wouldn’t have that food security if the fish weren’t there and the moose weren’t there. That has to be brought in cross-silo as well.

I know that where I live there have been efforts by the Wet’suwet’en, for instance, to engage in that discussion — I mean, it’s a natural discussion outside of government — to try to engage in that discussion, where you’re not just meeting with Forest, Lands and Natural Resource Operations and the Ministry of Environment and those agencies when it comes to activities on the land base, but you’re also bringing in MCFD and social services ministries, because when we’re talking about planning for kids’ futures, there’s no disconnection between those agencies.

The tone is set from the top, and the busy people working in those ministries have to have the direction from the political people to say: “Yeah, you can make time. You must make time. It is a priority to go to that table and sit together with the people who are rightful titleholders on the land base to make those kinds of decisions about how kids are going to be impacted in the future by decisions, whether it’s in resource extraction or otherwise.”

I think there’s a lot of work to be done, but it’s not unachievable. It’s what people are doing naturally, without government.

The question I had out of the report that strikes me is on page 13, where you’ve got median income for one-parent families decreasing drastically, I would say, from 2010 to 2011. This is median. It’s not average. It’s just the midpoint, so there are many single-parent families that are at under $31,000 after-tax income a year.

Do you have any explanation around that dramatic decrease? We had the so-called recession in 2008-09, but this a difference between 2010 and 2011. We still aren’t even back at the level of 2008 when you look at one-parent families.

M. Turpel-Lafond: Just a couple of comments, more broadly, with respect to this question, is the framing. How do we frame the issue of looking at deprivation, poverty, the families most affected? Obviously, our expert that we’ve relied on here, Dr. Kimberly Schonert-Reichl…. Some careful analysis of the data certainly reflects a concern which she describes as “poverty begets poverty.” How do you engage to respond to what goes with that for children and youth, which is when you have poverty, family dysfunction and trauma? How does that manifest itself in a society?

Well, one of the biggest challenges is not even just the material deprivation but how you promote resilience in a society that has a large social distance between high-income earners and high net worth individuals and people in poverty.

One of the reasons why we went to her as an expert and took her advice — she’s informed some very interesting things in this report — is to try and reframe it so we don’t think about these children and young persons as having a life filled with risk and failure and rethink it as to how we can build social connections and address what is really the burgeoning social distance that poverty has had in British Columbia and how it has impacted.

Obviously, your comments about the north…. Rural communities and others have experienced it, but they also have some buffers against it. You talked about the sharing food economy — not ideal. But promoting major projects, wage labour could disrupt some of the sharing economy, so in some of those communities, you want to think about social connections.

The expert really speaks to what we’ve tried to look at as indicators, which are school connectedness, participation in extracurricular activities for children and youth, volunteering and positive relationship with adults. These can be very protective. We can’t necessarily solve all of the drivers. We can mitigate, but how do we protect and promote resilience so you don’t basically say, “You’re starting out behind and you’re going to end up behind, as are your children and their children after them,” and so on?

That is the one dimension that I think is quite valuable here. Think about poverty. Deprivation is significant, and market basket measure is significant — but also the broader social drivers around how you keep children and youth connected to avoid the social distance. You have a vibrant society for children and youth at a certain income level, but the others are left behind, and the distance and connection is so broad.
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Unfortunately, I think that when you look at that trend, that chart on page 13, the hardest part of that is the social distance that continues to widen for vulnerable children. They’re experiencing diminished school connectedness, diminished participation in extracurricular activities, the barriers to transportation, the barriers to the costs.

The programs and services that actually engage and respond to support resilience need support. They need to be nurtured. They don’t occur without a positive public policy framework to promote them. And they need to be measured.

How well do we measure school connectedness? How well do we measure community connectedness, volunteering and so forth? These are key areas.

Your comment is an important one about trends, but what does that mean for children? What it means for children are massive concerns in British Columbia, in most neighbourhoods and regions, about social distance. Some areas have services that may be reaching out. Most have limited services. That’s a deep concern for the future.

I have two questions, one for Mary Ellen. I noticed back in 2013…. I have a recall of when you did this — sent out a challenge to post-secondary institutions asking them if they might consider waiving tuition for specific groups, for aboriginal youth or children in care. I noticed that most of them haven’t taken you up on that challenge. I’m just wondering why that is. What would be the reasons they would give you for not doing that?

M. Turpel-Lafond: We have now 13 of 25 post-secondary institutions that have either waived tuition or created programs to allow young persons who were formerly in care to attend college and university without having to pay tuition, or some other type of program to lower the barrier and support. That’s good. And 13 of 25 is better than zero of 25, where we were a few years ago.

I’d like to see 25 of 25. It could be done instantly. Government could actually refund all the tuition and make a commitment to every college and university, and it would be all done. It would have been done overnight, but that didn’t happen.

That’s fine. I’m a person that’s prepared to try every single door. So I persuaded the boards of governors in colleges and universities that it’s a minor expenditure and that they could eat that and that we could do things. Vancouver Island University has been a leader and has had great results.

The interesting piece of this, when we think about this report, is longitudinally following children and youth who experienced intense deprivation, maltreatment. Where are they when they’re 30? Obviously, Dr. Kendall and I…. We’ve done complete cohort studies. We did the study on youth justice, looking at, from birth, where a kid who is in youth justice — if they go on to be an adult offender. Or what happens? We like longitudinal…. We like to really take it apart and debate it and have evidence.

This is where the money’s at, in terms of interventions. I can just say: “All right. I had a very strong campaign, and 13 of 25 colleges and universities have waived tuition.” I can’t actually get a system in the government of British Columbia to evaluate what that means, because people don’t work together. Nobody has the lead for youth.

There is post-secondary here — which is great; I work with them. There’s K to 12. There’s MCFD; they’re done at 19. There’s CLBC. There’s Health. There’s income assistance. Can anybody come together and evaluate whether, you know, the 200 young people who have taken advantage of tuition waivers are going to have a better outcome later? And can we monitor and learn from it?

Well, we can’t in British Columbia, because we have these silos, which even on that…. It’d be nice to monitor, because we could see a lot of success. We’ve engaged the U.S. leading expert, Dr. Amy Salazar, who’s from Washington state. We have engaged her. She’s evaluating in the U.S. We can’t evaluate it in British Columbia. That’s an unfortunate piece, because there’s an indicator you would want to see how you…. If poverty begets poverty and you can increase the ability to have resilience later…. Maybe they’re not going to have it within an expected six years of graduation, but they’re going to get there later. What happens to their children?

These are really key areas where we should be able to do that. That’s a fixable thing. But these are often piecemeal. Perhaps we will get to that aha moment to say: “Gee, we should have done this differently.” We should try to make this easier, not harder. Regrettably, I find, when it comes to evaluating and understanding vulnerability and responding to it, there are a lot of ideological biases at play that are anti-research and anti-evaluation — and a lot of barriers.

Again, this is one piece of work. I would have liked to see it even more in depth and be done annually and really report, region by region, on where it is. But to even engage in this is an extremely challenging environment in British Columbia.

P. Kendall: In relation to accessing data, there is a little bit of an irony in that in the last decade or so, the protection of privacy and the concern over privacy has actually made it harder to share or access data that could be used to measure policy outcomes, because you do need to look across databases. And while Pop Data B.C. has a lot of health information which is available to researchers, it isn’t actually as available to people who want to evaluate the programs or the outcomes of what we’re actually doing. I just note that as a little bit of an ironic, unintended consequence of protection of privacy.
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D. Plecas: I just asked that question because there are so many institutions in the province that pride themselves or boast about being open access. It seems that those are the ones that are off your list here.

Anyway, my second question relates more to the general nature of the report. One of the things that I kept thinking as I was going through it was that it would be nice to have — I’m not saying that you had room to do this here — a report that spoke to: what are those pockets of success, those initiatives that can provide some hints towards what things might be happening on the ground or what we could do?

Learning outcomes, for example — I’m familiar with some of the things that are happening in my riding, and they’re pretty impressive success stories. I’m thinking, when you compare that to what’s happening generally, those success stories get masked when we’re just looking at the overall picture. I don’t mean that as a criticism, but I’m saying it would seem to be helpful to have such a report.

P. Kendall: That’s a very important point that you make, an observation. We try and include some in this report. The next report — the full report that’s coming out — will have examples of best practices.

M. Turpel-Lafond: Yeah, and in each of the six domains, what we did in this report is we set a promising practice. So in education, on page 65, we look at home instruction for parents of preschooler youngsters, which is called the HIPPY programs, which are interesting. More generally, on these issues about community connections, on page 87, we looked at the role of Big Brothers Big Sisters in a number of cities and towns in British Columbia and how their programming to connect young people to have positive community connections and low barriers is responding to exactly what we’re describing.

We tried to highlight some of the best practices that we can see. We always come back to an issue which is really significant there, which is scope, scale, evidence. Is there data? There is data there, but we always want to see: is it working? Dr. Kendall refers to random controlled trials, etc. You know, there are different levels of scrutiny and evidence that we look at. We’re pretty generous about how we look at this. But we really need to evaluate that. That needs to be an area of serious evaluation and, when it evaluates as a success, to have some stable commitment to fund it.

I think you saw this in your mental health report, where you highlight initiatives on mental health. I appreciate you didn’t evaluate them, but they look like promising practices. Then we have to come back to evaluation. Are they scope? Are they scalable? Will they work for people? These are really key issues. What is it that we want to address with those initiatives across the domains? Obviously, you always want to get the most that you can and, in a public sector setting, often for the least investment and to have community partnering.

That promising-practice piece is in our minds all the time. When you don’t have a children’s plan, and you don’t use evidence and evaluation regularly, it becomes a more impoverished discussion around: what is a promising practice?

The promising practices of 2007 maybe disappeared, because they don’t get continued or they may just now be evaluated or there is an evidence block. So the privacy and other issues are important — that we evaluate and we have these discussions. They’re not positional discussions. They’re really around these key indicators and outcomes.

J. Thornthwaite (Chair): Our last two questions are from Linda and then Jennifer. I think that’s all we’ll have time for.

L. Reimer: I guess my question is for Dr. Kendall. Talking about healthy birth weight, in here on page 22, you talk about risky maternal behaviours. I think we’re all aware of the dangers of smoking and drinking and taking drugs during pregnancy. You refer here to how low birth weight “carries increased risk of infant death and of developing learning, behavioural and emotional challenges” and then the risk also of high birth rate “associated with increased risk of death within the first month of life, as well as developmental and intellectual problems.”

You haven’t really told us here what exactly leads to low birth weight or which risky behaviour leads to low birth weight and which risky behaviour leads to high birth weight. That’s my question for you. If we’re trying to educate people who are acting in a risky manner, we need to pinpoint their behaviours so that their behaviours can change for the well-being of their unborn son or daughter.

P. Kendall: Absolutely. Thank you. Low birth weight is basically set at a number of 2,500 grams at birth. Now, if you’re born premature, you could be 2,500 grams, but you’re an appropriate weight for gestational age. If you’re born at term but you’re 2,500 grams, then you are smaller than about 95 percent of your other babies, so it’s important to make a bit of a distinction.

We look at singleton births because there’s been an increase in multiple births due to reproductive technologies. Obviously, somebody who is carrying two or three or four children in their womb…. Those babies are going to be smaller, so we take them out, because otherwise it makes it look like low-birth-weight rates are going up.

You have to try and nuance between: “Is this a premature birth?” and “What might be the reasons for premature birth?” Some of them are medical, and some of them are behavioural. Underweight, poor nutrition, stress and tobacco smoking can be linked with early birth, prematurity, and they can also be related to small-
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for-gestational-age, where particularly maternal nutrition and not putting on weight in the last two or three trimesters makes a difference.

Underlying it all, good prenatal care is a criterion, and we do see both prematurity and low birth weight associated with poorer prenatal care or lack of access to prenatal care. We also see them both associated with tobacco smoking, poor diets and maternal stress.

The high birth weight tends to be associated with maternal obesity. That is also a form of poor nutrition in that it’s nutrient-poor but high-calorie intake.

M. Turpel-Lafond: If I can just add, on the one prenatal, postnatal area where British Columbia has had a strategy in place, there is a ten-year plan on fetal alcohol spectrum disorder, FASD. Dr. Kendall was involved in informing that. We are now into, I believe, the seventh year of that.

That’s an example of an activity where Dr. Kendall and I or our successors should really be involved in a detailed evaluation of that, because prenatal alcohol consumption is highly correlated, as we know, with not birth weights but other lifelong challenges. It’s a preventable area. We’ve got a ten-year plan.

I was just able to participate in the national conference on fetal alcohol spectrum disorder in Vancouver last week, the second time I’ve participated in that process.

I met with the researchers and others to talk about, if we were to evaluate that, what their advice is on evaluation — and then also meet with children and youth and their families that are addressing fetal alcohol spectrum disorder and to have an idea about that.

It’s one area where, again, as a subset, it’s something we’d really need to look at. We have a plan. We’re seven years into it. We should really think about: have we seen those numbers come down? What are we learning? What are our experiences? Some deeper research, I think, will be warranted there, to say: did we make success? What worked? What didn’t work?

Hopefully, that’s an area where we can really target those risky behaviours that have an impact on children’s health and family well-being.

J. Rice: Carrying on with the conversation about maternal health, I appreciated, Dr. Kendall, that you mentioned the fact that it’s not necessarily risky behaviours that lead to low birth weight. I’ve been travelling around rural B.C. doing a tour called Maternity Matters. I’ve looked at the research from the Centre for Rural Health — the guys out of UBC that are looking at rural health issues with a big emphasis on maternity services.

Could you comment on the distance moms have to go to get maternal care and what that means as far as outcomes go?

P. Kendall: I’ve only really looked at that for aboriginal women, status Indian women. The review was some years ago, but it was clear that access to prenatal care was lower for mothers who had a status Indian flag and the outcomes were worse. But the ones who had worse outcomes also had higher rates of consuming alcohol or smoking or poor diet.

If you’re living in a rural community and you’re distant from care, then it is harder to access the kind of prenatal care, the antenatal care, that is recommended. You’re also probably — certainly if you’re living on reserve — likely to be in somewhat of an impoverished environment as well. So you get a cumulative effect.

Going back to sort of the standard prenatal public health services, when I was on the front line in the ’70s and the ’80s, the services were theoretically universal, but in fact, they tended to become kind of more the first come, first served. The people who came tended to be the more motivated or the higher-educated or the higher-income group.

We’ve been trying to shift, over the years, to what Clyde Hertzman called “proportional universality,” which would be kind of: you measure the input and the supports to where the need is. That goes back to some of the targeting you talked about, which we’re still not that good at doing in the health services. We tend to set a clinic up and wait for people to come. We don’t always set the clinic up in the place where it’s most needed.

J. Rice: Just one more question for Mary Ellen. I wanted to ask…. Your description of how siloed we are, looking at people siloed off, essentially — what jurisdictions are doing this right? What are the examples of governments that are taking that big picture and compiling all the data from the various ministries to actually measure outcomes?

M. Turpel-Lafond: Well, there are a number of jurisdictions. Again, I come back to the point that you can come at it through different lenses. If you come at it as a poverty plan, for instance — people have a bit of an allergic reaction to the word “poverty” — behind a poverty plan in other jurisdictions are really the social determinants of health that we’re talking about here. So I call it a children’s plan. Jurisdictions that have a children’s plan tend to have started to take down those silos and coordinate.

As I said earlier, there are other places that have done it. I think one of the persistent barriers we have is the way in which government and government service delivery has not embraced and supported aboriginal children and families.

Even the Ministry of Children and Families may do a big review internally of its services and forget to actually consult and engage aboriginal people — which they recently did, in fact, much to the chagrin of the aboriginal
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leadership. Then you go down a course, and you end up not having people together.

Public health issues and issues like the well-being of children require an approach that really comes from the perspective of improving wellness. Again, Dr. Kendall has extensive experience clinically, as a researcher and as a provincial health officer, but we’re not trying to promote some type of a strictly clinical model. This is a social…. It’s the macro and micro factors where we can make a difference to reduce vulnerability for children.

Obviously, with the levels of maltreatment and vulnerability, including poverty, that we have in British Columbia, we have some serious challenges to address. The upshot of this report is that five years after the first report, we have not seen any budging on those issues. So we need to try again. We should not keep doing the same thing that’s not working. We should try to do other things, and we should celebrate the small things we do.

We should be celebrating a lot more innovation. There’s a persistent challenge, perhaps a cultural challenge, to innovation because of those silos in British Columbia. That seems unnecessary, given the expertise and skill that we do have in different places, but they are not coordinated. Unfortunately, five years from now, we may not see any more progress, unless we slay that within the public administration.

J. Thornthwaite (Chair): Thank you very much, Mary Ellen, Dr. Kendall. We very much appreciate your report as well as your time today to come and present it to us.

With regards to the other items on the committee’s agenda, we don’t have any other items today, except that I’m going to throw out a date for our possible next meeting: May 19 — same time, eight to 9:45. We’ve got the two reports that I’ve referred to before, and if we can coordinate our schedules, I think that would work. But we can follow that up by email back and forth to make sure it works for everybody.

Do I have a motion to adjourn? Thank you, Darryl. A seconder — Maurine. We’re adjourned.

Access to on-line versions of the report of proceedings (Hansard)
and webcasts of committee proceedings is available on the Internet.

Chair:	Jane Thornthwaite (North Vancouver–Seymour BC Liberal)
Deputy Chair:	Doug Donaldson (Stikine NDP)
Members:	Donna Barnett (Cariboo-Chilcotin BC Liberal)
	Marc Dalton (Maple Ridge–Mission BC Liberal)
	Carole James (Victoria–Beacon Hill NDP)
	Maurine Karagianis (Esquimalt–Royal Roads NDP)
	John Martin (Chilliwack BC Liberal)
	Dr. Darryl Plecas (Abbotsford South BC Liberal)
	Linda Reimer (Port Moody–Coquitlam BC Liberal)
	Jennifer Rice (North Coast NDP)
Clerk:	Kate Ryan-Lloyd

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON CHILDREN AND YOUTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH